The clinical results of the Turnbull–Cutait delayed coloanal anastomosis: a systematic review

Abstract

Turnbull and Cutait described abdominoperineal pull-through followed by delayed coloanal anastomosis (DCA) in 1961. DCA could reduce anastomotic leaks, pelvic morbidity and use of stomas. Strong evidence about its clinical benefits is still lacking. This systematic review examined the clinical outcomes of DCA for the treatment of malignant or benign colorectal conditions. A systematic search of electronic medical databases was conducted. Two independent reviewers selected studies, extracted data and assessed risk of bias. The primary outcome was pelvic morbidity (anastomotic leak, pelvic abscess or sepsis, use of stoma). Fecal continence and survival data were also analyzed. From 1,251 citations, we included seven observational studies including 1,124 patients. All included studies were considered at high risk of bias. Two studies comparing DCA with immediate anastomosis reported a significant decrease in anastomotic leak, and pelvic abscess or sepsis. Low rates of pelvic morbidity were reported in the other five studies: anastomotic leak 0-7 %, pelvic abscess 0-11.8 % and pelvic sepsis 6.8-10 %. Rates of permanent stoma after DCA were low in six studies (1-6 %), with one study reporting an incidence of 25 %. Fecal continence was reported as satisfying in all studies. No differences were observed in a comparative setting. Survival data were reported in four studies. Clinical heterogeneity and methodological issues precluded meta-analysis. Based on retrospective evidence, DCA offers a low rate of anastomotic leak, pelvic morbidity and use of stoma, with reasonable fecal continence. Results are encouraging, but prospective studies are needed for comparison with standard of care.

What is the functional result of a delayed coloanal anastomosis in redo rectal surgery?

“…5,11 Ultimately, 10-20% will succumb to definitive stoma after rectal cancer surgery. Hallet et al 17 review of DCAA for primary surgery encountered fistula rates of <7%, with functional results comparable to primary CAA. 12 In Dulk's largest series of 924 patients, 19% of stomas were never reversed.…”

“…Indeed, in Lelong's series of 72 coloanal hand-sewn anastomosis for low rectal adenocarcinoma, about 91% of patients were free from stoma at the end of the study. [17][18][19] However, even if DCAA leads to a decreased fistula rate, it is not recommended as first-line treatment since functional results after primary coloanal anastomosis with colonic J-pouch or side to end anastomosis are significantly superior. 13 The management of these complications after rectal surgery is complex.…”

“…The second procedure was performed after a mean delay of 14 AE 3 days (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21), with no interval difference between sepsis, colovaginal fistula or colovesical fistula. During one procedure, a transanal drain was placed to treat a small posterior anastomotic leakage and was removed after 5 days of irrigation.…”

An Old Method Turnbull Cutait; Using for Middle and Distal Rectal Cancer Surgery without Ileostomy. Oncological and Fuctional Late Outcomes

“…11 In a systematic review by Hallet et al 12 , seven studies including 1,124 patients were evaluated and the T-C was associated with a low rate of anastomotic leakage, pelvic morbidity, and without using stoma which are among the main advantages of this technique. Anastomotic leakage increases local recurrence 4,12,13 and found to be an independent prognostic factor for local recurrence 14 therefore, decreasing anastomotic leak rates could even result in a positive effect on T-C. Anastomotic leakage and local recurrence were not observed in our study. Pelvic abscess developed in one patient on the 16 th postoperative day, antibiotic treatment was sufficient and no additional intervention was required.…”

Ultimate Stomaless Technique of Two-Stage Operation for Lower Rectal Cancer Performed on a Patient with a High Body Mass Index: The Reborn Operation (Novel Pull-Through Method)

“…The transanal pull-through procedure was an anus-preserving operation first introduced by Babcock [6] in 1932. However, pull-through followed by delayed coloanal anastomosis has nowadays been reported by only a few centers in France and the Cleveland Clinic in the USA [7,8].…”